Lumbar Disk Disease (Herniated Disk)

What is lumbar disk disease?

The vertebral column, or backbone, is made up of 33 vertebrae that are separated by
spongy disks. The spine is divided into 4 areas:

Cervical spine: The first 7 vertebrae, located in the neck

Thoracic spine: The next 12 vertebrae, located in the chest area

Lumbar spine: The next 5 vertebrae, located in the lower back

Sacral spine: The lowest 5 vertebrae, located below the waist, also includes the 4
vertebrae that make up the tailbone (coccyx)

The lumbar spine consists of 5 bony segments in the lower back area, which is where
lumbar disk disease occurs.

Bulging disk. With age, the intervertebral disk may lose fluid and become dried out. As this happens,
the spongy disk (which is located between the bony parts of the spine and acts as
a “shock absorber”) becomes compressed. This may lead to the breakdown of the tough
outer ring. This lets the nucleus, or the inside of the ring, to bulge out. This is
called a bulging disk.

Ruptured or herniated disk. As the disk continues to break down, or with continued stress on the spine, the inner
nucleus pulposus may actually rupture out from the annulus. This is a ruptured, or
herniated, disk. The fragments of disc material can then press on the nerve roots
located just behind the disk space. This can cause pain, weakness, numbness, or changes
in sensation.

Most disk herniations happen in the lower lumbar spine, especially between the fourth
and fifth lumbar vertebrae and between the fifth lumbar vertebra and the first sacral
vertebra (the L4-5 and L5-S1 levels).

What causes lumbar disk disease?

Lumbar disk disease is caused by a change in the structure of the normal disk. Most
of the time, disk disease happens as a result of aging and the normal break down that
occurs within the disk. Sometimes, severe injury can cause a normal disk to herniate.
Injury may also cause an already herniated disk to worsen.

What are the risks for lumbar disk disease?

Although age is the most common risk, physical inactivity can cause weak back and
abdominal muscles, which may not support the spine properly. Back injuries also increase
when people who are normally not physically active participate in overly strenuous activities. Jobs that require heavy
lifting and twisting of the spine can also cause back injuries.

What are the symptoms of lumbar disk disease?

The symptoms of lumbar disk disease vary depending on where the disk has herniated,
and what nerve root it is pushing on. These are the most common symptoms of lumbar
disk disease:

Intermittent or continuous back pain. This may be made worse by movement, coughing,
sneezing, or standing for long periods of time

Spasm of the back muscles

Sciatica – pain that starts near the back or buttock and travels down the leg to the
calf or into the foot

Muscle weakness in the legs

Numbness in the leg or foot

Decreased reflexes at the knee or ankle

Changes in bladder or bowel function

The symptoms of lumbar disc disease may look like other conditions or medical problems.
Always see your healthcare provider for a diagnosis.

How is lumbar disk disease diagnosed?

In addition to a complete medical history and physical exam, you may have one or more
of the following tests:

Magnetic resonance imaging (MRI). A procedure that uses a combination of large magnets, radiofrequencies, and a computer
to produce detailed images of organs and structures within the body.

Myelogram. A procedure that uses dye injected into the spinal canal to make the structure clearly
visible on X-rays.

Computed tomography scan (also called a CT or CAT scan). An imaging procedure that uses X-rays and computer technology to produce horizontal,
or axial, images (often called slices) of the body. A CT scan shows detailed images
of any part of the body, including the bones, muscles, fat, and organs. CT scans are
more detailed than general X-rays.

Electromyography (EMG). A test that measures muscle response or electrical activity in response to a nerve’s
stimulation of the muscle.

How is lumbar disk disease treated?

Typically, conservative therapy is the first line of treatment to manage lumbar disk
disease. This may include a mix of the following:

Bed rest

Education on proper body mechanics (to help decrease the chance of worsening pain
or damage to the disk)

Physical therapy, which may include ultrasound, massage, conditioning, and exercise
programs

Weight control

Use of a lumbosacral back support

Medicine to control pain and relax muscles

If these measures fail, you may need surgery to remove the herniated disc. Surgery
is done under general anesthesia. Your surgeon will make an incision in your lower
back over the area where the disc is herniated. Some bone from the back of the spine
may be removed to gain access to the disc. Your surgeon will remove the herniated
part of the disc and any extra loose pieces from the disc space.

After surgery, you may be restricted from activity for several weeks while you heal
to prevent another disc herniation. Your surgeon will discuss any restrictions with
you.

What are the complications of lumbar disk disease?

Lumbar disk disease can cause back and leg pain that interferes with daily activities.
It can lead to leg weakness or numbness and trouble with bowel and bladder control.

Can lumbar disk disease be prevented?

Maintaining a healthy weight, participating in regular exercise, and using good posture
can lessen your risk for lumbar disk disease.

Living with lumbar disk disease

Conservative therapy requires patience; but sticking with your treatment plan can
reduce back pain and minimize the chance of worsening pain or damage to the disk.
Conservative measures and surgery can both take time to be effective.

When should I call my healthcare provider?

Call your healthcare provider if your pain increases or if you start having trouble
with bowel or bladder control.

Key points about lumbar disk disease

Lumbar disk disease may occur when a disc in the low back area of the spine bulges
or herniates from between the bony area of the spine.

Lumbar disk disease causes lower back pain and leg pain and weakness that is made
worse by movement and activity.

The first step in treatment is to reduce pain and reduce the risk of further injury
to the spine.

Surgery may be considered if the more conservative therapy fails.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.

Before your visit, write down questions you want answered.

Bring someone with you to help you ask questions and remember what your provider tells
you.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.

Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.

Ask if your condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if you do not take the medicine or have the test or procedure.

If you have a follow-up appointment, write down the date, time, and purpose for that
visit.